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To the Editor—Bacterial meningitis is a severe disease with substantial mortality and morbidity despite the availability of effective antimicrobial agents and adjunctive therapies [1, 2]. Recently, a study involving adults with community-acquired bacterial meningitis in Malawi showed that coinfection with Epstein Barr Virus (EBV) occurred in 79 of 149 bacterial meningitis patients (53%) and that EBV load was associated with higher mortality [3]. Coinfection with cytomegalovirus (CMV) was detected in 7% of patients. A high proportion of patients (77%) in this study were human immunodeficiency virus (HIV) positive, which was found to have a strong influence on the rate of coinfection with EBV and CMV. The aim of the current study was to establish whether herpes viruses and other neurotropic viruses could be detected in the cerebrospinal fluid (CSF) of adult bacterial meningitis patients in a Dutch population with a low HIV infection rate.

We analyzed CSF samples from a random subset of bacterial meningitis patients included in a nationwide prospective cohort [4]. Patients were included if they had community-acquired bacterial meningitis confirmed by CSF culture or if CSF results showed at least 1 individual predictor of bacterial meningitis, defined as a glucose level of <34 mg/dL, a ratio of CSF glucose to blood glucose of <0.23, a protein level of >220 mg/dL, or a leukocyte count of >2000 cells/μL [5]. Informed consent was obtained from all participating patients or their legally authorized representatives. CSF was stored locally at −80°C, after which it was brought to the Academic Medical Center (Amsterdam, the Netherlands), where samples were thawed once, spun down, aliquoted, and again stored at −80°C until analysis. Nucleic acid was extracted by automated extraction (MagnaPure, Roche Diagnostics), and reverse transcription using random hexamers was performed. Five microliters of reverse transcription reaction was subsequently used to detect EBV, CMV, herpes simplex virus 1 and 2, varicella-zoster virus, adenovirus, enterovirus, human parechovirus, and human herpesvirus types 6 and 7 simultaneously in an internally controlled 4-tube real-time multiplex assay.

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